Several studies have confirmed that sleepiness and sleep disorders are common in persons with epilepsy. Patients with partial epilepsy have twice the incidence of drowsiness as people who do not have epilepsy, and this significantly worsens quality of life. Much of this may be related to sleep apnea that is frequently undiagnosed. Children with epilepsy have higher scores for poor quality sleep, anxiety about sleep, and disordered breathing. Children with epilepsy show more sleep problems than did controls, and these were associated with seizure frequency, age, paroxysmal activity on EEG, duration of illness, and behavioral problems. Patients taking anticonvulsants known to disrupt sleep (phenobarbital, phenytoin, carbamazepine, or valproic acid) have increased drowsiness compared to epilepsy patients who are not taking anticonvulsants.

Other possible reasons for disrupted sleep fall into several categories, including the effects of seizures,, insufficient sleep, inadequate sleep hygiene, and coincident sleep disorders.

Insufficient sleep syndrome

One of the more common reasons for inadequate sleep is perhaps the most obvious- failing to spend enough time asleep! This is common in the general population, and is largely a cultural phenomenon. The demands of modern society, including work, family, and leisure time often cause people to limit their sleep time. Although most believe this to be benign, chronic sleep deprivation can clearly result in problems with memory and concentration. Persons with epilepsy are certainly not immune from this, although the magnitude of this problem is unknown.

Sleep hygiene

Sleep hygiene is a fairly straightforward concept, but it is one with which a large number of people are unfamiliar (including many physicians). The basic principle of sleep hygiene is optimization of the conditions for sleep. Contrary to many people’s beliefs and to the accepted norms of American society, humans do not have full voluntary control over sleep, as with (at least to a greater extent) eating and voiding. Many would like to believe that sleeping and waking are like a switch, on and off, but this is simply not true. Although maximizing the conditions for sound and restful sleep cannot be fully controlled, it can be encouraged and this is the principle of sleep hygiene.

First, sleep should have regular timing. People have many processes that are based on a twenty-four hour clock (more or less), and sleep is one of them. Other physiological aspects of this clock are changes in core body temperature and release of hormones including melatonin, cortisol, and growth hormone. All of these processes can adapt to outside influences (as in changing time zones or during shift work), however these changes occur gradually and rapid alteration in daily schedules are not well tolerated. As such, optimum sleep cannot be attained when awakening at 6 AM on weekdays and noon on weekends. Napping excessively can disrupt sleep. If a 4-hour nap is taken until 6 PM, then the person will clearly not be tired at midnight. He will then stay up late, and either need to sleep late in the morning (further disrupting sleep) or will awaken early, possibly taking another nap during the day because of excessive tiredness.

Second, the sleep environment should be optimized, physically and psychologically, for sleep. Physically the bedroom should be suitably dark and quiet. It should be shielded from distracting noise (traffic, other people who arise earlier, etc). The bed should be comfortable, and the temperature should be optimized. Psychologically, the bedroom, and particularly the bed, should be associated with sleep and not with other (particularly active) activities. People should refrain from activities in their bed other than sleep, particularly stressful activities (doing work, studying, or balancing the checkbook). Sexual activity can be either alerting or relaxing, therefore the timing of this in relation to sleep should be individualized. It is also sometimes necessary to avoid reading or watching television in bed. Sleeplessness in bed should be treated not by ruminating and staring at the clock; this tends to again associate the bed with anxiety. If this happens, arise from bed and do quiet activities, returning to bed only when sleepy.

Finally, outside activities that can influence sleep must be monitored. Activities that tend to stimulate – particularly exercise – should be avoided late in the day (although exercise earlier in the day generally improves nighttime sleep). Alcohol before bedtime should be avoided because it can result in early morning awakening. Caffeine, chocolate, nicotine, and other stimulants should be avoided late in the day.

While these principles are relatively simple, it is amazing how many people do not think about them. Getting counseling or information about sleep hygiene can make a big difference in the quality of one’s sleep.

Topic Editor: Carl Bazil, M.D.
Last Reviewed:10/01/05